(ETDs)
Spring 5-2018
An Exploratory Study on Perceptions of (IPE)
Towards Interprofessional Practice in Athletic
Training
Carolyn Goeckel goeckeca@shu.edu
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Recommended Citation
Goeckel, Carolyn, "An Exploratory Study on Perceptions of (IPE) Towards Interprofessional Practice in Athletic Training" (2018). Seton Hall University Dissertations and Theses (ETDs). 2489.
AN EXPLORATORY STUDY ON PERCEPTIONS OF (IPE)
TOWARDS INTERPROFESSIONAL PRACTICE IN ATHLETIC TRAINING
By
Carolyn Goeckel
Dissertation Committee
Genevieve Pinto Zipp, PT, Ed.D (Chair) Vikram Dayalu, Ph.D., CCC-SLP
Anthony Breitbach, PhD, ATC
Submitted in partial fulfillment of the
Requirements for the degree of Doctor of Philosophy in Health Sciences Seton Hall University
Copyright © 2018 Carolyn Goeckel All Rights Reserved
ACKNOWLEDGEMENTS
I would like to offer my sincere gratitude and thank you to my family, friends, and colleagues who have supported me throughout my Ph.D. journey. To my sister Marianne who provided expert editing throughout the many stages of my dissertation. To all my colleagues and friends from SHMS for your encouragement over the years especially Mary, Irene, and Meryl. To Dr.
To my dissertation committee member Dr. Breitbach, thank you. My
and commitment to advance the profession. To my dissertation committee member Dr. Dayalu, thank you for your insight and support throughout my dissertation. Knowing you were on my committee help keep me grounded and reminded me that I could and would achieve this goal.
Foremost, to my dissertation chair, Dr. Zipp. Thank you for believing in me dissertation topic was inspired by being part of the white paper and your passion
my behalf is greatly appreciated. Without your guidance, direction and persistent throughout my long journey. Your endless patience, time and efforts on
help this dissertation would not have been possible.
Maher who agreed to be my expert reader and who always provided sound advice. To my department chair Dr. Vicci Lombardi for allowing me the time and freedom to complete my degree and to the AT faculty faculty for your support and understanding throughout my Ph.D. studies.
TABLE OF CONTENTS ACKNOWLEDGEMENTS ... 4 TABLE OF CONTENTS ... 5 LISTING OF FIGURES ... 8 LISTING OF TABLES ... 8 ABSTRACT ... 10 Chapter I ... 12 INTRODUCTION ... 12
Background of the Problem ... 18
Purpose of Study ... 19
Significance of Study ... 20
Conceptual Framework... 21
Research Questions and Hypothesis ... 24
Chapter II ... 27
LITERATURE REVIEW ... 27
Impact of IPE on Students ... 27
Impact of IPE on Faculty... 31
Impact of IPE on Healthcare Professions ... 33
IPE Location ... 40
Delivery of IPE into Curricula ... 40
Adult Learning Theory ... 42
Summary ... 44
Chapter III ... 46
METHODS ... 46
Study Design ... 46
Qualitative Procedures ... 49
Instrumentation Design ... 52
Variables ... 54
Independent Variable (IV) ... 54
Dependent Variable (DV) ... 55
Data Collection Procedures ... 55
Selection Criteria ... 58
Inclusion Criteria ... 58
Exclusion Criteria ... 58
Sample Size of Population ... 59
Chapter IV ... 61
RESULTS ... 61
Descriptive Statistical Analysis ... 63
Quantitative Data Analysis ... 66
Research Question One ... 67
Research Question Two ... 68
Research Question Three ... 70
Research Question Four ... 73
Qualitative Data Analysis ... 74
Research Question Five ... 75
Research Question Six ... 80
Research Question Seven ... 84
Chapter V ... 87 DISCUSSION ... 87 LIMITATIONS ... 95 CONCLUSION ... 96 REFERENCES ... 98 ... 50
On-line Survey Design ... 50
Demographic Profile... 51 Interdisciplinary Education Perceptions Scale (IEPS)
APPENDIX A ... 116 SHU IRB ... 117
LISTING OF FIGURES
FIGURE 1 ... 22
THEORY OF REASONED ACTION,FISHBEIN AND AJZEN (1975) AND THEORY OF PLANNED BEHAVIOR (AJZEN,1985) ... 22
FIGURE 2. ... 47
MIXED METHODS CONCURRENT EMBEDDED DESIGN CRESWELL AND PLANO-CLARK (2011) ... 47
FIGURE 3: ... 57
PROCEDURE AND DATA COLLECTION PROCESS ... 57
LISTING OF TABLES TABLE 1. ... 60
REQUIRED SAMPLE SIZE CALCULATION ... 60
TABLE 2. ... 60
SURVEY RESPONSE RATE ... 60
TABLE 3: ... 63
DEMOGRAPHIC CHARACTERISTICS OF SAMPLE POPULATION (N=188) ... 63
TABLE 4: ... 65
RESULTS OF THE INTERDISCIPLINARY EDUCATION PERCEPTION SCALE (IEPS) ... 65
TABLE 5: ... 66
DESCRIPTIVE STATISTICS IEPSCOMPOSITE SCORE ... 66
TABLE 6 ... 68
RESULTS OF INDEPENDENT T-TEST GROUP MEAN DIFFERENCES (AT STUDENTS,AT PROFESSIONALS)IEPSCOMPOSITE SCORES... 68
TABLE 7: ... 70
RESULTS OF AN INDEPENDENT SAMPLE T- TEST, BETWEEN GROUPS (AT PROGRAMS ALIGNED,AT PROGRAMS NOT ALIGNED WITH OTHER HPP) ... 70
TABLE 8: ... 72
RESULTS OF INDEPENDENT T- TEST, BETWEEN GROUPS (RECEIVED STRUCTURED IPE, DID NOT RECEIVE STRUCTURED IPE) ... 72
TABLE 9: ... 74
RESULTS OF A ONE-WAY ANALYSIS (ANOVA) BETWEEN SUBJECTS ... 74
(BACHELOR’S,ELM,PPM,DOCTORATE) ... 74
TABLE 10 ... 79
HEALTHCARE PROFESSIONALS THAT ATSTUDENTS NEED EXPOSURE ... 79
TABLE 11 ... 80
SAMPLE RESPONSES FROM AT STUDENTS AND AT PROFESSIONALS ... 80
TABLE 12 ... 82
RESPONSE RATES FROM AT STUDENTS AND AT PROFESSIONALS ... 82
TABLE 13 ... 84
SAMPLE RESPONSES FROM AT STUDENTS AND AT PROFESSIONALS ... 84
TABLE 14 ... 86
SAMPLE RESPONSES FROM AT STUDENTS AND AT PROFESSIONALS ... 86
TABLE15 ... 91
ABSTRACT
An Exploratory Study on Perceptions of (IPE) Towards Interprofessional Practice in Athletic Training
Carolyn Goeckel
Context: Healthcare professional, including athletic trainers (ATs), are called to be collaborative-ready practitioners to effectively meet the needs of today’s patient-centered care. Currently, little research exists exploring the infusion of IPE (interprofessional education) practices in athletic training programs or its effectiveness in producing collaborative-ready athletic training professionals. While research is needed to evaluate whether IPE learning models can produce AT professionals that are collaborative-ready for PCC
(patient-centered care) several foundational questions should be addressed. First, educational researchers need to establish an understanding of athletic trainers’ perceptions toward interprofessional practice (IPP), IPE, and the athletic trainer’s role as perceptions are often linked to action. Additionally, exploring if perceptions of IPE are different amongst practicing athletic trainers and athletic training students would aid in providing a strong
foundation for educators as they develop IPE learning experiences that are meaningful. Objective: To explore athletic training students and AT
professionals perceptions toward interprofessional practice in athletic training using the Interdisciplinary Education Perceptions Scale (IEPS). Additionally, to identify factors in the demographic profile that impact perceptions of knowledge, skills, and abilities towards interprofessional practice among athletic training students and professionals. Design: A concurrent mixed method embedded design. Setting: Online survey instrument. Participants: 386 athletic training program directors received an email invitation to
participate in the study with the request to forward the survey link to students, alumni, and preceptors. The final sample population size was (N=188).
Interventions: Participants completed the Interprofessional Education
Perceptions Survey (IEPS, McFadyen et al., 2007), a demographic profile and three open-ended questions. Results: Overall, the average mean scores on the IEPS was high, 62 out of 72, suggesting positive perceptions toward IPE and IP collaboration between the variables tested. An independensamples t-test (α= 0.05, t= (68.2)-.16, p =.88.) conducted between athletic training students (M=61, SD±12.71) and athletic training professionals (M=62, SD ±.064) was found to be statistically not significant. Suggesting no difference in perceptions between athletic training students and AT professionals. Results of an independent t-test (α= 0.05 t= (185), 0.74, p= .23 between programs located with other health profession programs (HPPs), (M = 64, SD ±9.6) and those not located (M = 62, SD ± 7) with other HPPs was found to be
statistically not significant. A very small, but significant difference t (161) =1.64, p=.051(one-tailed), d=.3 was found on IEPS composite scores
between participants who received structured IPE instruction (M=62, SD ±8.7) and participants’ who did not (M=59, SD±10.6). Results suggest participants who received structured IPE, had slightly more positive perceptions of IPE and collaborative practice. ANOVA results for the four academic degree levels (Bachelor’s, ELM, PPM, Doctorate), F (3, 184) = 1.72, p =.17 was found to be statistically not significant. Results suggest no difference in perceptions of IPE and collaborative practice between academic degrees. Results from the open-ended question identified simulation lab, case scenarios and hands-on as highly relevant to the students learning
experience. Conclusion: In this study, athletic training students and athletic training professionals, highly valued IPE, IP collaborations, and recognized its impact on PCC. Understanding one’s self and one’s beliefs, behaviors and attitudes enable a professional to identify possible areas of collaboration with other disciplines. It creates openness, understanding of working together, and developing skills for teamwork. Therefore, while perceptions do not infer actions or produce identified behavior, it does provide the foundational base to support the body of knowledge regarding IPE effectiveness.
Chapter I
INTRODUCTION
Together with the healthcare community, the field of athletic training (AT) has evolved as a health profession. Remaining consistent throughout this growth is the interdisciplinary approach that exists among all the health professions. This collaborative and team-based approach to patient care is the hallmark of America's changing health care system (IOM, 2013). It is also the result of growing awareness and the need to improve the quality of patient care, patient safety and cost efficiencies within the healthcare system (WHO, 2010). Athletic training as a health profession is grounded in educational preparation and dates back to the founding of the profession in 1950 by the National Athletic Training Association (NATA) (Delforge & Behnke,1999; Mensch & Ennis, 2002; Weidner & Henning, 2002). Therefore, for athletic trainers to advance as a healthcare professional and integral member of providing patient-centered care (PCC), it is important “to know the past, to understand the present, which will guide the future” (Carl Sagan).
During the 1960s and 1970s, athletic training education was rooted in apprenticeship-based training within intercollegiate athletics. Athletic training programs (ATP) were part of a unit in physical education, primarily offering a
minor or concentration in athletic training. It was common for program faculty to hold dual appointments and employed by both departments of
intercollegiate athletics and physical education (Delforge & Behnke, 1999, Perrin, 2007).
As time went on, and with the continued growth of the profession, a uniform educational structure in preparing athletic training students for practice began to emerge (Perrin, 2007; Dodge, Walker & Laur, 2009). Over the next twenty years, significant contextual changes resulted in a more formal curricular model (Weidner and Henning 2002). Educational standards and content broadened as programs began to develop more specialized
coursework specific to athletic training (Delforge & Behnke, 1999). In 1990, a milestone event occurred when the American Medical Association (AMA) officially acknowledged athletic training as a health
profession. Recognition from the AMA was pivotal in moving the profession of athletic training forward as a healthcare profession. Additionally, in 1996, the NATA Board of Directors endorsed recommendations from the educational task force, a group charged to develop a strategic plan to advance the profession. Aligning AT programs with peer health professions educational programs was a key and important recommendation of the task force report. Part of this recommendation stated that multidisciplinary coursework is coordinated with the teaching and exposure to other appropriate health professions (Breitbach, Brown, 2011). Another key recommendation of the
task force included a dedicated academic major in athletic training. This started the phase-out of the internship route, which ended in 2004 (NATA Education Task Force, 1997).
In 2012, the NATA Board of Directors approved a proposal by the Executive Committee for Education (ECE), for the future direction to athletic training education. The committee recommended interprofessional education (IPE) should be “a required component in athletic training professional and post-professional education programs” (NATA recommendation 3, 2012). Another significant recommendation is the transition of the terminal degree in athletic training from the bachelor to master degree by the year 2022.
Following the growth and evolution of the athletic training profession from the 1950s, and its organizational roots into the 1990s when athletic training was recognized as a health profession, illustrates the great strides made in advancing the profession. Professional preparedness of athletic trainers has progressed from an apprenticeship-based training program provided through physical education and intercollegiate athletics to dedicated academic majors in the health professions. The key, however, is consistency. While these changes continued to position athletic training better and align athletic trainers as peers to other healthcare professions, they also
contributed to varying levels of knowledge about the athletic training
profession by the public, peer health professions and within the profession itself. As a result, the "desire of athletic training to be recognized as a ‘bona
fide’ health profession persists today" (Breitbach A. & Richardson, 2015). Athletic training continues to face significant challenges as a health
profession, including gaining recognition as an integral member of the healthcare team that contributes to patient-centered care (PCC).
One challenge to overcome is the limited awareness athletic trainers have of their and other health professions. The profession needs to articulate a uniform and consistent description when identifying an athletic trainer. The World Health Organization (2010, p.7) defined interprofessional education as “learning about, from, and with other health professions”. The sequence of the wording is intentional. Before students learn from and with other professions,
Miller (2008), athletic training students need to gain a more accurate understanding of the professional role and responsibilities of the certified athletic trainer. Equally important is the need for other health professionals to learn and understand the role and responsibilities of the athletic trainer.
Gaining an understanding of one’s discipline, and the roles and responsibilities of other disciplines help develop a self-professional identify, defines
professional boundaries and offer opportunities where collaboration might be found (Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011). An important concept in the establishment of IPE, practice, and collaboration, is the ability to summarize the knowledge base of the discipline. IPE helps students to students first need to learn about their profession. According to Mensch and
understand their own professional identity while gaining an understanding of other professional’s roles on the health care team (Bridges et al., 2011).
Athletic trainers regularly practice collaboratively, working side by side with the team physicians and other medical specialists to ensure that patients’ care is safe, effective and efficient. This working relationship between
professions is based largely on communication and an overall understanding and appreciation of each other's role in delivering health care (Finkham, 2002). However, another challenge the profession faces is that (IPE) has always been implied and not explicitly addressed. As a result, athletic trainers lack the mastery of the terminology and definitions associated with (IPE). Moreover, few collaborative opportunities exist between athletic trainers with other health care professionals. This lack of collaborative opportunities has created a limited awareness by peer healthcare professionals about the role and responsibilities of an athletic trainer. The athletic training profession is often not included in discussions of interprofessional education (IPE) at the institutional and governmental levels. Being left out of the conversation results in limited opportunities to learn together, which in turn effects collaboration between disciplines, and ultimately can affect patient-centered care.
These challenges faced by the athletic training profession are a
reflection of the silo mentality, where health professions’ education is isolated and involved only in developing knowledge, skills, and abilities associated with its' profession (Towle, 2016). The solution is to break down these silos
for improved and consistent care that result in positive patient outcomes. More often than not, health care professionals usually operated within its distinct silo. This mindset is a product of students taught in separation or a “silo like” environment resulting in educational viewpoints that are isolated and offers limited awareness of other health professionals (Barr, Freeth,
Hammick, Koppel, & Reeves, 2006; Campbell, Stowe & Ozanne, 2011, D Amour, Ferrada-Videla,San Martin Rodriguez & Beaulieu, 2005; Oandasan & Reeves, 2009).
Interprofessional education in health professions education is a way to help students gain knowledge of the roles and contributions of their and other health professions. The expectation is that this experience will produce a level of mutual respect and collaboration between these students when they
become health professionals and help them increase the cooperation and communication necessary to deliver patient-centered care (PCC) that is safe, timely, efficient, effective and equitable (Barr et al., 2006, Towle, 2016). Health care professionals need to understand and rely on each other to provide “more comprehensive services, greater efficiencies in the delivery of care, increased patient satisfaction and ultimately better patient care and health outcomes” (Curran, Deacon, and Fleet, 2005, p. 77).
The goal of interprofessional education (IPE) is collaborative practice, and the key to patient-centered care is to focus on IPE. Therefore, IPE is an opportunity to provide future athletic trainers’ with knowledge, skills, and
abilities to improve patient outcomes, advance the profession and solidify an athletic trainers’ role as a contributing member of the interdisciplinary team that delivers patient-centered care within today’s healthcare system. Moving forward into a patient-centered care model, the challenge is to think broadly. As the profession of athletic training looks to the future, it has to prepare itself in the present. Now is the time to break down the silos, to explore the
opportunities and actively address how to prepare future athletic trainers for collaborative practice.
Background of the Problem
The NATA acknowledged that advancing the athletic training profession as an interprofessional health care provider lies within the
educational program's preparation of the students. In 2012, the NATA Board of Directors approved a proposal by the Executive Committee for Education (ECE), for the future direction in athletic training education. The ECE
developed a strategic plan to advance recommendation 3 and the IPE
initiative. A work group formed in 2013 to collaborate on a white paper for the purpose to serve as a resource on IPE and interprofessional practice (IPP) in athletic training (Breitbach & Richardson, 2015). The white paper acts as a resource on (IPE) and (IPP) as a component into entry-level and post-professional athletic training education. By exploring pedagogy, the white paper provides the framework for educational programs to move forward with implementing (IPE) into the AT curricula. The content further is intended to
inform the profession and other stakeholders on the background of (IPE) and interprofessional practice (IPP) in athletic training and enhances the
awareness of the importance of (IPE) in AT practice (Breitbach & Richardson, 2015).
However, apart from these initiatives, several questions remain unanswered on IPE effectiveness in the development of athletic trainers for IPP. First, there is currently little evidence on the delivery of (IPE) or its effectiveness in AT programs. Thus, research is needed to evaluate whether IPE learning experiences can produce athletic training professionals that are collaborative-ready for PCC. Additionally, outcomes addressing the impact of IPE and the promotion of IPP among athletic trainers need to be established. However, before answering these questions, we argue that several
foundational steps need to be taken. First, as researchers, we must seek understanding athletic trainers’ perceptions of IPE, IPP and if IPE supports IPP given what we know about how perceptions influence actions (Ajzen, Joyce, Sheikh, & Cote, 2011).
Purpose of Study
The purpose of the current study was to explore athletic training students and AT professionals perceptions towards Interprofessional education and interprofessional practice in athletic training using the
Interdisciplinary Education Perceptions Scale (IEPS). Additionally, to identify factors in the demographic profile that impact perceptions of knowledge,
skills, and abilities towards interprofessional practice among athletic training students and athletic training professionals.
The objective was to gather and analyze the data on pre-existing perceptions of athletic trainers and athletic training students’ confidence and competency towards interprofessional practice. Also, explore where, when, and how they acquired this knowledge, skills, and abilities.
Significance of Study
Athletic training looks to advance the profession and solidity an athletic trainers’ role as a contributing member of the healthcare team. Exploring athletic trainer’s pre-existing perceptions gives insight into their confidence and competence of IPE and interprofessional practice. Knowing ATs perceptions of IPE and IPP strengthens the body of evidence, guide future studies and is the first step in the continued development and
assessment of the impact of IPE towards interprofessional practice in athletic training. Outcomes will help establish a baseline knowledge, and lay the groundwork for further study and evaluation that will help determine whether IPE learning experiences can produce collaborative-ready interprofessional AT professionals. Building upon this knowledge base will inform and provide valuable insight that will aide athletic training educators as they seek to infuse interprofessional education (IPE) into the curricula. Ultimately, identifying whether IPE prepares athletic trainers as a health care member who provides patient-centered care resulting in positive patient outcomes.
Conceptual Framework
This study looked to explore athletic trainers’ existing perceptions of whether IPE does or not prepare them for collaborative practice. Ajzen’s and Fishbein’s (1975, 1985) Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB) provide a base framework to explore athletic training students’ and athletic trainers’ perceptions toward interprofessional practice. Social cognitive theories refer to theories where individual beliefs and thoughts are viewed as processes prevailing between perceptions and actions (Godin, Belanger-Gravel, Eccles & Grimshaw, 2008). According to social theorists, “the most important predictor of behavior is the intention to perform that behavior” (Ajzen, Joyce, Sheikh, & Cote, 2011). Fishbein & Ajzen (1975) proposed a theoretical model for understanding behavior centered on the attitude construct. Their Theory of Reasoned Action (TRA) looked at behavioral intentions, attitude (direct and indirect) and the influence of social norms (Figure 1). In this theory, attitudes are a function of the underlying beliefs about the behavior. Seen as the perceived expectation to perform the behavior, subjective norms are the motivation or intention to act on the behavior. Together, attitude and subjective norm influence behavior through intention.
Ajzen’s (1985) theory of Planned Behavior(TPB),links beliefs and behavior. (Figure 1). It is a theory explaining human behavior and is an extension of (TRA). Ajzen intended to improve the predictive power of the
(TRA) by adding to the original theory a perceived behavioral control (Madden, Ellen, & Ajzen, 1992). The Theory of Planned Behavior states, “behavioral achievement depends on both motivation (intention) and ability (behavioral control)" (Ajzen et al., 2011). The perception of the individual refers to a view of what a person believes or thinks which influence intentions that can predict behaviors and ultimately actions (Rhodes, Blanchard, & Matheson, 2006). The most important predictor of the actual behavior is the intention to perform a specific behavior. In the TPB, attitude toward the behavior, subjective norms, and perceived behavioral control, together shape an individual's behavioral intentions and ability to carry out the behaviors (Ajzen, 1991).
Figure 1
Theory of Reasoned Action, Fishbein and Ajzen (1975) and Theory of Planned Behavior (Ajzen, 1985)
A systematic review conducted in Canada by Godin, Belanger-Gravel, Eccles, & Grimshaw, (2008), aimed to predict healthcare professionals'
intentions and behaviors. The key question the authors wanted to answer was which theoretical construct is most relevant for the study of health care
professionals’ behavior. The review specification included study’s using a social cognitive theory approach. Seventy-eight studies met the inclusion criteria. Among these, seventy-two provided information on the determinants of intention and sixteen prospective studies provided information on the determinants of behavior. Seventy of the seventy-two studies included looked at the purpose of behavior.
The authors reported that concerning the factors explaining intention, “the most consistently significant cognitive factors (i.e., at least 50% of the time) were beliefs about capabilities, beliefs about consequences and the social/professional role and identity” (Godin et al., 2008). The theory most often identified was the TRA or its extension the TPB. When researchers are looking to predict behavior in the health professions Godin et al., (2008) concluded that the TPB is an appropriate construct for studies that explore health-care professionals' behavior and intention.
Understanding one’s self and one’s beliefs, behaviors and attitudes enable a professional to identify possible areas of collaboration with other disciplines. It creates openness and understanding of working together and developing skills for teamwork. Therefore, while perceptions do not infer
actions or produce identified behavior, it does provide the foundational base to support the body of knowledge regarding IPE effectiveness.
Research Questions and Hypothesis
This study explored athletic trainers’ perceived knowledge, skills, and abilities towards interdisciplinary collaboration. Four questions explored athletic trainers’ perceptions of interprofessional education and teamwork as identified by the level of agreement to the items on the Interdisciplinary Education Perception Scale (IEPS). Three additional questions looked to explain further and understand the impact of IPE on the practice of athletic training.
The four quantitative questions and hypothesis addressed in this study included:
RQ1: Is there a significant difference in athletic training students' and AT professionals' perceptions of interprofessional practice (IPP) in athletic training as identified on the Interdisciplinary Education Perceptions Scale (IEPS) composite score?
Ha1: There is a significant difference in AT students’ and AT
RQ2: Do athletic training programs, located within the same academic unit as other health profession programs (HPP), lead to significant differences in AT students’ and AT professionals’ perceptions of IPP as identified on the IEPS composite score?
Ha2: AT students’ and AT professionals whose athletic training
program is located within the same academic unit, as other (HPP) will present with significantly higher IEPS composite scores than those who are not.
RQ3: Does structured IPE instruction lead to significant differences in AT students’ and AT professionals’ perceptions of IPP in athletic training as identified on the IEPS composite score?
Ha3: AT students’ and AT professionals’ who received structured IPE
instruction during their education will present with significantly higher IEPS composite scores than those who do not receive structured IPE instruction.
RQ4: Does academic degree level lead to significant differences in AT students’ and AT professionals’ perceptions of IPP as identified on the IEPS composite score?
Ha4: AT students’ and AT professionals’ with the highest earned academic degree will present with significantly higher IEPS composite scores than those who do not.
To further expand he quantitative findings, three open-ended questions looked to add depth, as themes within and across the participants’ responses were explored to add insight into their perceptions. Findings from research question five, six and seven, looked to verify, explain and strengthen the quantitative results of this study.
The three qualitative questions addressed in this research study included:
RQ5: What professionals do you believe the athletic training student should be exposed to during academic preparation to support (IPE)? Please briefly explain why.
RQ6: Where do you think (IPE) is best learned? Please briefly explain why.
RQ7: Would you recommend or not recommend Interprofessional Education to other members of your discipline? Please briefly explain why
Chapter II
LITERATURE REVIEW
The goal for students engaged in IPE is to learn how to function in an interprofessional team and carry this knowledge, skill, and value into their future practice. Ultimately as part of a collaborative team, the goal of IPE and IPP initiatives is providing patient care that focuses on improving patient outcomes (Buring, Bhushan, & Brazeau, 2009). Through the history and development of IPE, the importance of collaborative practice to reduce
practice errors and improve quality of care and patient outcomes are evident. To improve IPE education and its contributions to future practice, the
following literature review includes studies that explored the effects of IPE in facets of the healthcare system.
Impact of IPE on Students
According to Oandasan & Reeves, (2005), students favor IPE more when the experiences are directly relevant to their current or future practice, and collaborative practice increases efficiency and understanding of
interprofessional roles (Richardson, Letts, Childs, et al., 2010). One goal of IPE is the improvement in the level of confidence for communicating across
professions, and a positive influence on students’ willingness to continue learning together throughout their professional preparation (Breitbach et al., 2015).
A study conducted by Klocko et al., (2012) aimed to improve students’ communication and teamwork skills while allowing them to learn more about health professions outside their discipline. In a new curriculum, Klocko
explored if health profession students’ (N=12) attitudes toward communication and teamwork improved while they learned more about health professions outside their discipline. The author hypothesized that exposure to a new curriculum over a period of two semesters would positively influence students understanding of communication and teamwork. Klocko (2012) found that student attitudes improved, as they perceived to have gained more
confidence towards communication and teamwork skills.
Mueller, Klingler, Paterson & Chapman, (2008) surveyed OT, and PT clinicians from Canada in both private and public practice, (97%) of the respondents agreed it is essential for OT & PT students to be involved in IPE during their training. Fifty-seventy percent of OTs and (43%) of PTs agreed received the appropriate level of IPE training during their entry-level training. The majority or (65%) of the overall responses chose clinical placement as the location/time IPE should be completed. Twenty-six percent chose the classroom and (5%) chose “other.”
In a cross-sectional study, Makino, Shinozaki, et al., (2013) examined if alumni who studied in an IPE program at a pre-licensure stage maintained a positive attitude toward collaborative practice (CP) once graduated and in practice. Students who participated were enrolled in PT, OT and nursing programs respectively. Students in a first-year lecture reported negative attitudes toward collaborative practice while students enrolled in the third year clinical course reported positive attitudes towards collaborative teamwork. Overall, the mean score of alumni was significantly lower compared to
students currently enrolled. However, it is important to note that this was not a longitudinal study and the alumni surveyed was not the same cohort
surveyed when enrolled in the program. Results identified that students possessed more positive attitude towards IPE than alumni did in clinical practice. Findings from this study suggest that changes in professional identity in a team may be due to contact with patients after graduation in the postgraduate clinical healthcare experience. Further, the reduction of
attitudes toward healthcare teams in the postgraduate clinical experience may be related to “team efficacy”.
In a longitudinal study conducted in Newfoundland, Curran et al., (2008) explored student attitudes toward IPE. The authors examined the effect of IPE on attitudes toward IPE, attitudes toward interprofessional teamwork and overall satisfaction with IPE curriculum. Participants included undergraduate students enrolled in the school of pharmacy, school of social
work and the schools of nursing. The authors concluded that overall, students from across professions reported positive attitudes towards the concept of interprofessional teamwork.
In another study, Coster & Norman et al., (2008), investigated the development of health students’ attitudes/perception and readiness for IP learning among several health profession disciplines including PT, OT, and nursing. The authors reported most students on entry begin the program with high positive attitudes towards IPE and collaborative practice and that these positive attitudes diminish over time. One explanation that the authors gave is that upon entrance, students had a higher perception of their skill and abilities and as they progressed through the program those perceptions were effected by experiences and a more advanced didactic component.
The purpose of a study by Hood, Cant, Baulch, et al., (2013) was to explore the perceptions of senior nursing, midwifery, nursing-emergency health (paramedic), medical, physiotherapy and nutrition-dietetics students toward interprofessional learning (IPL).Using the Readiness for
Interprofessional Learning Scale (RIPLS), the authors surveyed across disciplines (N=741) and reported a (46%,) response rate. Highest ranked response agreed across disciplinary groups. The top five rated items were determined by all disciplines and included recognizing the importance of learning together to develop “trust and respect among students. Other highly rated items included recognition that “patients would benefit if students
worked together to solve a patient’s problems and learning with other students will help them become a more effective member of a health care team.” Overall, students from all disciplines demonstrated a positive attitude towards, and active support of, interprofessional learning and, interestingly, those with IPL experience had significantly stronger attitudes towards participation in IPL compared with those without IPL experiences.
Impact of IPE on Faculty
The faculty is stakeholders in IPE. Faculty members report benefits of IPE such as increased collegiality with other team members, significant opportunity to model IP collaboration in the classroom and community, and increased scholarship opportunities (Breitbach et al., 2013). Ho (2008),
identified several barriers that affect IPE and faculty who are constructing IPE experiences. He found a significant obstacle for faculty involved in IPE
included a limited understanding of other professions. Additionally, faculty from different professions may have different professional values, cultures, biases, and they may not fully understand what other health professionals do in a collaborative environment (Ho, 2008). According to the IOM (2010), it is important that faculty develop professional trust among team members and work to model interprofessional collaboration by developing, supporting, and sustaining cooperation across participating disciplines. Many faculty and preceptors have not been formally instructed in team approaches during their professional education and likely did not have explicit training in either leading
or being part of, collaborative efforts (Gilbert, 2005).
Common collaborative methods to enhance and forward goals of IPE include IPE courses, clinical/fieldwork (practice) education, and information technology (Gilbert, 2005; Oandasan & Reeves, 2005). Faculty members may need help constructing and evaluating IPE, however. IPE is more than just putting multiple disciplines into the same class. IPE activities must include specific and measurable objectives and evaluation metrics to assess outcomes (Gilbert, 2005). There is uncertainty in how to measure IPE
competency-based models. A multipoint-of-view approach should be used to plan and evaluate the outcomes and value of IPE (IOM, 2010). Community-based health professionals can help faculty understand the needs and priorities of the patients and future employers to identify purposeful goals of IPE during planning phases (IOM, 2010).
Faculty support from higher-level administration facilitates a culture change, which embraces IPE organizationally. Examples of organizational barriers in which administration can help include class scheduling and facility availability (IOM, 2010; Ho, 2005; Breitbach, 2013). In addition, Breitbach et al. (2013) and Aston (2012) identified that IPE is very time intensive for the faculty to develop and deliver, thus, the workload should be adjusted. Upper-level administrators should further support faculty involved with IPE through appropriate merit increases, and recognition of faculty IPE activity during the promotion and tenure process (Gilbert, 2005).
Further research is necessary to explore benefits of IPE for faculty and students. IPE contributes to better communication, understanding of other’s roles and responsibilities, improved teamwork, learning how to interact with other professionals, improved team functioning, and trust in other team members. Planning of IPE activities is time consuming, detail oriented and requires commitment and persistence. Significant barriers for faculty, students, and preceptors to IPE include disciplinary and prior interaction biases, faculty buy-in for breaking down disciplinary silos, coordination of program schedules, faculty development, and limited role models. Support from the higher-level administration for IPE and strong leadership advocating for IPE is necessary for IPE to succeed and be impactful.
Impact of IPE on Healthcare Professions
The fundamental definition of coordinated health care involves recognizing the talent and ability of each member of the interprofessional team (Hall, 2005). Collaboration and teamwork among health care
professionals are essential aspects of the delivery of high-quality patient care. Research has demonstrated that interprofessional cooperation in practice improves patient care and outcomes, reduces medical errors, and enhances job satisfaction and retention (Schroder et al., 2011). The next generation of health care professionals must be prepared to function successfully in this culture. Various entities, such as the Institute of Medicine and American Board of Medical Specialties, have suggested that the preparation of the
health care workforce should include interprofessional education (IPE) (Batalden, Ogrinc, & Batalden, 2009). They identified healthcare
competencies for all healthcare providers, regardless of discipline. These skills are consistent with the foundational behaviors of professional practice identified within the NATA Education Competencies for professional
education (NATA, 2011). The competencies include evidence-based practice, patient-centered care, interprofessional education and collaborative practice, healthcare informatics, quality improvement, and professionalism (Batalden et al., 2009).
Traditionally, the professions of nursing and medical schools have been the driving force behind advances in interprofessional education (IPE) as well as clinical practice. The American Association of Colleges of Nursing (AACN) identifies interprofessional learning as an expected competency for masters (2011) and doctoral preparation (2006). Along with nursing,
pharmacy also includes IPE in its accreditation guidelines (ACPE, 2011). The American Colleges of Pharmacy (AACP) largely advocated that “all colleges and schools of pharmacy provide faculty and students meaningful
opportunities to engage in education, practice, and research in
interprofessional environments to better meet the health needs of society” (Krobath et al., 2007, ACCP White Paper, 2017, p.6). The National League for Nursing (NLN) recommends repeated and systematic IPE experiences, matching student levels across disciplines. The gold standard for
implementation of these experiences was through carefully planned and developed simulations to gain an appreciation for all skills the various professions provided in an environment where discussions could take place (NLN, 2012).
In a study to assess commonalities in interprofessional education accreditation mandates across professions, Zoreck (2013) found that accrediting agencies lack a universal mandate/standard for IPE. Although health professions identify and recognize the importance of interprofessional education and interprofessional practice, the current approach to IPE
standards across health professions is uni-professional (Zoreck, 2013). The authors reasoned that establishing one universal IPE standard would create baseline preparation of IPE across the health professions. This approach offers a way to address the challenge for graduates to experience IPE and appreciate other health professional roles and responsibilities, and the added ability to collaborate to improve the delivery of health care to patients
effectively (Zoreck, 2013). A conclusion can be made that all health care professionals, throughout the United States and including the profession of athletic training, need to act in unison and collaborate to create one universal IPE standard. To this end, Hertwick et al., (2012) suggested educational programs should require each applicant of a health professions program to shadow different healthcare providers/professionals in varied health care settings as part of the admissions process.
Jones et al., (2012) performed a review of the status of IPE in the first clinical experience of pharmacy students. The results of the review indicated schools with multiple health profession programs have more success with the integration of interprofessional education into the clinical environment. The review also identified a lack of tools to assess IPE in pharmacy practice experiences.
While few accreditation standards specifically address required interprofessional education in physical therapy, there are numerous
indications of interprofessional practice. Physical therapists collaborate with many other personnel involved with the patient/client. “The academic
environment must provide students with opportunities to learn from and be influenced by knowledge outside of, as well as within, physical therapy” (CAPTE 2013). “The physical therapist professional curriculum includes clinical education experiences for each student that encompasses opportunities for involvement in interdisciplinary care” (CAPTE, 2013).
One concrete example where physical therapy, athletic training education, and other healthcare professions, have similarities in
interprofessional education comes in the form of service learning. Service learning, as an interprofessional education experience, may maximize the opportunity to understand the patient-centered care and the importance of collaboration among health professionals (Bridges et al., 2010). Collaborative work among health care professions is the key to quality interprofessional
patient/client care. Interprofessional collaboration in health care is considered a high priority, as concerns about patient safety and the need for effective and efficient care have reached alarming proportions (Bainbridge, Nasmith, & Orchard, 2010). Service learning is an easy way to overcome many of the IPE challenges, such as varying schedules, while providing the students’
opportunities for collaborative learning outside the traditional academic setting.
The current healthcare environment is becoming increasingly reliant on team-based care and interdisciplinary training for its practitioners (Tucker et al., 2003). Healthcare reform in the US will require today’s health science students to be able to function well in interdisciplinary teams to maximize efficiency and effectiveness in patient care. Numerous studies found that the quality of patient care increased. Noted was the increased level of teamwork among healthcare professionals (Ferrell & Winn, 2006;Headrick, Barton, & Ogrinc, 2012; Hobgood, Sherwood, & Frush, 2010; Calman, Hauser, Lurio, Wu, & Pichardo, 2012; Korner, Ehardt, & Steger, 2013; Nadolski, et al., 2006). Most educators in the health professions realize intuitively that health science students need multiple instructional events and opportunities to practice interdisciplinary teamwork. They also need to see their respective health science faculty members working together in a collegial way to internalize the importance of mutual respect and reliance among healthcare disciplines (Hall et al., 2001).
Interprofessional education initiatives allow students across health care professions to learn to collaborate effectively with each other and learn what areas their scope of practice might overlap with other professions. IPE fosters a deeper understanding of how their professional expertise may best work with another health care provider to achieve good patient outcomes (Mueller et al., 2013). Interprofessional education further strengthens students own professional identity and increases awareness of the need to educate others about his/her professional role as a healthcare professional (Lie et al., 2013). Additionally, early exposure to different professions and the health care system may lead to a more positive view of interprofessional collaboration among the different health profession students and entry-level professionals (Hertwick et al., 2012).
Athletic trainers have consistently worked side by side with team physicians and other medical specialists to ensure that together, the care provided for physically active individuals is delivered effectively. This close working relationship is based mainly on excellent communication and an overall understanding and appreciation of each other's role in delivering health care (Finkham, 2002). A growing number of orthopedic doctors
continually look to employ athletic trainers in a physician’s offices to increase practice efficiency, revenue, and productivity, while ensuring patient
education and satisfaction (Brockenbrough, 2009).
care and better patient outcomes.
One challenge that athletic training must overcome is to develop a more uniform description of who athletic trainers are as a health care provider and define roles and responsibilities of daily practice. Clarke & Hassmiller (2013), linked “roles and responsibilities in interprofessional practice require each discipline come to the table with the ability to articulate the knowledge base of their discipline”. An important concept in the establishment of interprofessional education, practice, and collaboration in athletic training is the ability to summarize their knowledge base. As various health care professions pursue increasing educational preparation and consequent recognition of their clinical abilities, athletic trainers must effectively
communicate their value as part of the healthcare team. Our strong link to supervising physicians should continue to pave the path towards increased awareness and recognition of our educational preparation and clinical expertise.
Athletic training can learn from the early endeavors of nursing and medicine into the interprofessional education journey (Thibault, 2011).
Answers to the major questions as to when to implement, how long, and what is required, is crucial to the success of IPE for athletic training. Athletic
training needs to view the IPE experience as a continuum for lasting effects for the learner to occur. The discipline of athletic training is committed to
understanding the capabilities of the various health care professionals interacting with on a daily basis and recognize their value, as well a shared vision for better health care and education (Kruse, 2012). In return, athletic trainers should foster collaborative efforts to further solidify their place as part of the interprofessional team.
IPE Location
Throughout the literature, more success with the integration of IPE is noted when health professional programs are housed together. A set of studies looked at the location of HP programs for the promotion of IPE within the programs and throughout the curriculum. Jones, Blumenthal, et al., (2012) reviewed the status of schools of pharmacy IPE experiences. Out of 116 US colleges of pharmacy, 95 colleges (82%) responded. Schools with multiple health profession programs, (more than six programs) were more likely to have IPE and had more success with the integration of IPE. The authors concluded that common institutional alignment with “peer”
professions, by both by their academic level and the academic unit might facilitate opportunities for other programs seeking IPE involvement.
Delivery of IPE into Curricula
From the literature review, it was identified that students respond positively to IPE, but it is unknown if early IPE experiences have a positive
impact on students' learning together throughout their professional
preparation. Questions arise about the timing of introducing (IPE), and the research literature is mixed when to start formal (IPE) (Jones, Blumenthal, Peterson, et al., 2012). Though students may not initially understand the complexities of interprofessional relationships, research supports the importance to develop a common framework of best practices early during professional preparation (Jones et al., 2012; Mueller et al., 2013; Hertwick et al., 2012). On the other hand, studies also suggest that IPE may not be beneficial early in pre-service education because students need to develop a clear sense of their professional identities before fully understanding the professional identity of others (Bronstein, 2003).
Lie, Walsh et al., (2013) conducted a study to elicit the opinions from second-year PA students (N=21) attending University of California on the delivery of (IPE). Two groups of students on the same geriatric clinical rotation, one group part of an interprofessional team and one group not part of an interprofessional team, were polled after the completion of the rotation. The authors found agreement among all PA students that (IPE) should be required and introduced early.
In England, Pollard, Miers, Gilchrist, & Sayers, (2006) explored the readiness for interprofessional learning at different times of their education among students from nursing, midwife, physical therapy PT, occupational therapy, social work, mental health, and special education. The study
surveyed student perceptions during and after their education and if these opinions changed over time. The authors reported that most students on entry begin the program with high positive attitudes towards IPE and collaborative practice and that these diminish over time. The authors postulated that students upon admission to the program overestimated their skill level. Diminished attitudes reflected unrealistic perceptions of IPE. Diminished beliefs, the authors felt, were the result of bad experiences and interactions during clinical rotations, which caused a loss of confidence in communication and teamwork. The authors also acknowledged that the students lose focus on the value of IPP as a result of the demands of the specific skill set and abilities required (Pollard et al. 2006).
Overall, studies showed that students who received IPE during their education program reported perceptions of more confidence in their abilities towards IPP after graduation. Learning should be included in curricula in all degree programs. The debate continues but perhaps earlier in the course of study counteracts negative stereotypes or attitudes and encourages the development of interprofessional collaboration skills (Hood et al. 2013).
Adult Learning Theory
Research supports that IPE initiatives need to be grounded in a theoretical model, connecting theory to practice. A review of IPE models published between 2005 and 2010 identified only forty-seven percent of the
published studies reported the use of learning methods in the development and implementation of the IPE program. Additionally, how the theories were used and which approaches were most effective in IPE development was not always clear (Abu-Rish et al., 2012). The literature offers several theoretical frameworks for IPE development and implementation. These include adult learning theory, contact hypothesis, reflective practitioners, experiential learning, social identity theory, and intergroup contact theory (Oandasan, & Reeves 2005, Clark, 2006, Abu-Rish, Et Al., 2012, Khalili et al., 2013). According to Abu-Rish (2012), the adult learning theory and contact hypothesis theory were the most commonly implemented and cited. One adult learning theory commonly referenced in healthcare
education is Kolb’s experiential learning theory (ELT). In this method, learning is described as a process through which experiences can affect how
individuals develop and synthesize knowledge that they gain through
experiential learning experiences (Kolb, 1984, 41). The adult learner is guided by Kolb's theory, which has two assumptions. First, the learner can adapt and change his/her knowledge, skill, and attitude to experiential learning and second; learning continues to evolve after the completion of the learning cycle to a more complex level (Davies & Gidman, 2011). This achievement directs the learner to another set of experiences, which in turn leads him or her to another cycle of learning (Poore et al., 2014).
Health profession disciplines, such as nursing, use Kolb’s Experiential Learning Theory’s (ELT) approach to learning (Baker et al., 2008; Lisko & O'Dell, 2010). Poore et al., (2014) recommended Kolb's ELT to guide
simulation-based IPE to improve communication and collaboration with health professional students. The authors found that utilizing Kolb's theory provided a foundation and process for the individual learner who participates in the simulation.
The research of Baker et al. (2008), Dillon, Noble, and Kaplan (2009), and IOM (2010), recognized the use of IPE as an effective teaching strategy in early co-education of students from different professions in the healthcare field. From the data analyzed in this study, experiential learning was
identified as a preferred method and a good fit for athletic training. Summary
Existing studies have shown that there is little definitive information available on the effectiveness of IPE activities for healthcare professional (HCP) students. It has been demonstrated that IPE may give students opportunities to learn about other professionals and develop a sense of autonomy. However, the reasons behind and the extent to which students' perceptions of inter-professional collaboration change after structured IPE are not well understood.
To fully inform institutions of the value of IPE, more rigorous evaluation of the impact of students' perceptions on IPE towards IPP is needed. The
literature showed that students respond positively to IPE. Studies demonstrated that students who received IPE curriculum during their education program reported perceptions of more confidence at graduation about their skills towards IPP. Further, the literature showed more success with the integration of IPE when health professional programs were housed together.
Though the research reports many positive outcomes in regards to IPE, gaps in the literature still exist. There is no consensus within the
research to determine the best time to implement IPE. Uncertainty still exists if early IPE experiences have a positive impact on students' learning together throughout their professional preparation. What was also learned from the literature is that there is limited research in the area of AT on IPE. Also, there is no evidence to support that perception of confidence and competency in IPP in AT is the result of formal IPE education. Therefore, research supports the need to investigate further athletic trainers’ attitudes and perceptions to improve education and future practice.
Chapter III
METHODS
Study Design
The current study explored athletic trainers' and athletic training students' perceptions of (IPE) and interprofessional practice (IPP) in athletic training. To answer the questions purposed, the researcher implements Creswell & Plano Clark (2011), concurrent mixed method embedded design. Creswell & Plano-Clark (2011, p. 92), describe this design as a collection and analysis of both qualitative and quantitative data in combination, on the same topic, and at the same time. In an embedded design, a traditional quantitative or qualitative design is determined the primary method that guides the study and a secondary or lesser “embedded” design offers a supportive role to the overall findings of the study (Creswell, Plano-Clark, 2011).
For this study, embedded into the more substantial or primary quantitative design was the smaller qualitative design (Figure 2). The quantitative results provided the researcher a general understanding of the research problem. To expand on these findings, three open-ended
the overall outcomes. The qualitative findings refined and further strengthened and validated the quantitative results.
Figure 2.
Mixed Methods Concurrent Embedded Design Creswell and Plano-Clark (2011)
According to the research literature, the collection of both quantitative and qualitative data provides different but complimentary data that is merged, so in combination, can generate more understanding of the findings than either research approach can offer alone. The researchers described mixed methods as a type of investigation that “validates the findings generated by each method through evidence produced by the other” (Creswell; Hanson et al, 2005; Clark.2005; Reeves et al., 2015). Kroll and Neri, 2009, p 42). Amid the limited literature that exists on (IPE) and (IPP) in athletic training,
conducting a mixed method embedded design helped to establish a base knowledge.
Quantitative Procedures
Initial data analysis included screening the data for assumptions of normality and equality of variance across sample populations. Research literature had shown that the parametric methods examining differences between means, for sample sizes greater than five, “do not require the assumption of normality”, and will yield nearly correct answers (Portney & Wadkins, 2009 pgs. 85 & 437; Norman 2010). The sample size for the factors explored in this study was higher than five, and therefore, met the assumption of normality. To retain the ‘robustness’ in the analyses, a parametric approach was used.
Exploring (RQ1 thru RQ-4), quantitative analysis was conducted using SPSS version 24 software. An independent t-test or one-way analysis of
variance (ANOVA) tested for the differences between groups as identified on the overall IEPS scores. The alpha significance level for analysis was set at p >.05 for all statistical tests. Levene’s test of equality was computed, meeting the assumption of equal variances across samples, unless a violation is noted. Appropriate post hoc analysis was conducted if the results identified significant mean differences.
Qualitative Procedures
Qualitative analysis of the three open-ended questions, research questions five thru seven (RQ5-RQ-7), further explored athletic trainers’ perceptions of IPE and the future of IPE for the athletic training profession. The first part of each question was straightforward (closed-ended) and sought single word answers to the following; RQ5) what health professions AT
students should be exposed, RQ6) what is the best learning environment for IPE and; RQ7) do you or do you not recommend IPE for AT students.
Pre-determined A priori codes/categories or themes were generated from the characteristics of the phenomenon being studied and based on earlier work; from theories and literature reviews; from local, commonsense constructs; and from researchers’ values (Bulmer 1979; Strauss 1987;
Maxwell 1996; Ryan & Russell, 2003). This approach of generating concepts from theory or previous studies is useful for qualitative research, especially at the inception of data analysis (Berg, 2001). Research question five and seven were derived from theoretical constructs, the researcher’s experience, and from the literature (Kolb, 1984; Breitbach & Richardson, 2015). The pre-determined themes for research question six was derived from the published core competencies for interprofessional collaborative practice established in 2011 by the Interprofessional Education Collaborative (IPEC, 2011).
The researcher sought to achiever inter-rater agreement with a second coder, a Seton Hall University faculty member from the School of Health and
Medical Sciences, who is a qualitative expert. Each coder separately
analyzed AT students and AT professionals responses to each question. For this study, a summative content analysis involved counting and comparing the keywords and interpreting the responses (Hsieh & Shannon, 2005). Categories and themes emerged from the data, and greater than (90%) agreement on the content was established between the two coders
comments to explain the initial quantitative results and identify trends. For this study, responses examined by the researcher helped to expand, verify and clarity the quantitative findings.
Instrumentation Design On-line Survey Design
Embedded instrument design is defined by Creswell and Plano-Clark (2011, p.105),as integrating a qualitative component within a traditional, validated quantitative design instrument. The current study’s design was structure following Creswell’s instrument design. The researcher developed one online survey with three separate sections. Participants were asked to complete a revised version of the Inter Educational Perceptions Scale (IEPS)
a traditional and validated survey instrument developed by McFadyen, A. K., Maclaren, W. M., and Webster, V. S. (2007). The twelve items on the (IEPS) identified if there were significant differences in the level of agreement
amongst athletic trainers’ perceived confidence and competency toward IPE and (IPP). The composite score on the IEPS served as the dependent variable for this study.
The demographic data helped establish whether the individuals in the study were a representative sample of the target population for generalization and to identify possible outliers within the population who participated. In this study, specific factors identified from the demographics served as the
independent variables.
At the end of the demographic questions, the researcher asked the participants to respond to three open-ended questions. By integrating an embedded instrument design, with a smaller qualitative component into the primary quantitative instrument, the researcher met the intent of the
concurrent embedded design used in this study. Demographic Profile
The researcher developed the demographic profile. The profile
included thirteen questions to identify characteristics of the study’s population and factors that may influence the participant’s perceptions of IPE. General characteristics of the population included; age, gender, years of experience and work setting. The demographic variables (IV) explored in this study
other health profession programs, formal, structured instruction in IPE and academic degree.
The vetting process to establish clarity and content validity included feedback from peer students during research forum. After revisions, an expert panel of peer colleagues within the health professional education programs vetted the profile. After two additional revisions, the final profile gained approval by consensus. The final questions on the demographic profile included three open-ended questions. The development and vetting process for the open-ended questions was the same as for the demographic profile. Interdisciplinary Education Perceptions Scale (IEPS)
The researchers, McFadyen, Maclaren, and Webster (2007) developed the revised version of the Inter Educational Perceptions Scale (IEPS) and was the survey instrument of chose used for this study. Information on the IEPS can be found at nexusipe.orqlmeasurement-instruments and is available in the public domain.
Throughout the IPE literature, the revised version of the IEPS is considered a validated and widely utilized tool in survey research studies (Blue, Chesluk, & Conforti, 2015; Goelen, De Clercq, Huyghens, & Kerckhofs, 2006; Zoller & Blue, 2012; Vaughan, Macfarlane, Dentry, & Mendoza, 2014; Arthur, et al., 2012).
Luecht et al., (1990) developed the original Interdisciplinary Education Perception Scale (IEPS), which consists of 18 statements. The survey statements are framed to gather attitudes towards interprofessional
one's professions' capabilities, and contributions; collaboration with others; and trust of others' judgment (Luecht, 1990). Luecht et al., (1990) established content validly of the instrument by consulting five faculty researchers who used their clinical expertise to determine the factors most relevant for IPE.
feedback on the survey from eight different healthcare disciplines. In the revised version, statement items did not change; however, McFadyen et al., (2007) remodeled the subscale (SS) structure and removed six statements found redundant. The revised version of the survey is a
twelve-item tool. McFadyen et al., (2007) organized the statements into three subscales: competency and autonomy, the perceived need for cooperation and perception of actual cooperation. Subscale one (SS1) refer to
perceptions of one’s professions roles and responsibilities. Subscale two (SS2) refers to understanding perceptions of one’s professional identity both positive and negative and explores the need for interdisciplinary cooperation
explore perceptions of teamwork and collaboration (actual cooperation) between one’s profession and other professions. The revised (IEPS) instrument demonstrates greater stability of the tool when collecting
perceptions of interprofessional education (McFadyen, 2007). The authors reported test-retest reliability of .6 and reported good internal consistency for the total scale Cronbach’s alpha value (α = .87 - .88) (McFadyen, 2007). McFadyen (2005) established construct validity of the original (IEPS) from
